FUE without propecia/finasteride?

[baldingeagle_]

Hi, 

I am starting to research FUE options. I am probably between Norwood 5 and 6. My first question is: is it possible to get FUE and not use finasteride after, without negatively impacting the transplanted hair? I have spent a fair bit of time researching finasteride and have firmly arrived at the conclusion that I would not like to take it. Given this, is it still a good idea to get a transplant? I would really like to have a head full of hair again but certainly not at the risk of the finasteride side effects. For context, I am located in the US (in case that's relevant in terms of the surgical procedure norms here - I read somewhere most surgeons wouldn't do FUE unless the patient agrees to commit to finasteride post-surgery?).

Thanks for any thoughts you might have on this!

[1978matt]

It's a gamble but to what degree depends on a number of variables like age, family history, area of balding versus area of donor etc.

If you post some pictures & more detail I'm sure people will chime in.

[Britanium]

It’s entirely you’re choice not to take Fin, I don’t either and quite a few members here don’t. But be prepared for chasing the loss, even higher Norwood's can get benefits from using Fin, strengthening the donor area/maintaining current hair, not as common is people seeing improvements.. 

What age are you ? Can we see any pics ? 

[RTC]

25 minutes ago, J.A.C said:

It’s entirely you’re choice not to take Fin, I don’t either and quite a few members here don’t. But be prepared for chasing the loss, even higher Norwood's can get benefits from using Fin, strengthening the donor area/maintaining current hair, not as common is people seeing improvements.. 

What age are you ? Can we see any pics ? 

Agreed

I do not want to take any AR blockers orally whatsoever. The risk and potential side effects are just not worth it for me.

I have made a compromise in trying topical Dutasteride though - I will see how that goes, but I will use that very conservatively to avoid any risk of it going systemic.

[Melvin- Admin]

I have had 4 HT's now and I don't take finasteride, nor did I take finasteride when I started my journeys. However, I will be trying the topical version. Back when I had my first HT in 2014 topical finasteride didn't exist, unless you had it compounded for a ton of money at a pharmacy.

[NARMAK]

19 minutes ago, Melvin- Moderator said:

I have had 4 HT's now and I don't take finasteride, nor did I take finasteride when I started my journeys. However, I will be trying the topical version. Back when I had my first HT in 2014 topical finasteride didn't exist, unless you had it compounded for a ton of money at a pharmacy.

Also, in complete fairness didn't you stop due to side affects once you finally did get on Finasteride? 

I think side affects are a very real thing, but it seems like the vast majority of men who take the medication generally tolerate it well and without serious side affects that would hopefully help them keep their hair for much longer. 

I do wish though we get much more effective treatments soon because i think in 2022, it's pretty weird we have had the same treatments from 1997 or so to rely on right now and not made any in roads despite the issue affecting billions. 

[Vann]

32 minutes ago, NARMAK said:

Also, in complete fairness didn't you stop due to side affects once you finally did get on Finasteride? 

I think side affects are a very real thing, but it seems like the vast majority of men who take the medication generally tolerate it well and without serious side affects that would hopefully help them keep their hair for much longer. 

I do wish though we get much more effective treatments soon because i think in 2022, it's pretty weird we have had the same treatments from 1997 or so to rely on right now and not made any in roads despite the issue affecting billions. 

It is a very very small minority of men who actually get side effects. Now everyone has different types. But majority of people that have taken the drug claim to have sexual side effects which were already pre-existing, some claim side effects as they get older but may not be due to the drug, and some who actually have side effects dont notice them because it happened early on when taking the drug.

Now im not saying it doesnt exist, but some people claim to have side effects too early. While some who have taken the drug for the long run may say in the first x amount of time I had xyz happen but that has stopped.

Majority of reported side effects when taking the drug, finasteride, are increased pain/swelling in testicles and hair shedding. Both of these symptoms have only been reported early on (people that have taken the drug for 2+ years).

This was from a study I pulled up from a library resource I have to pay to get the article but it was a scholarly study conducted between 1,000 men taking finasteride and 1,000 men on a placebo.

Short story of the study was that most men under 30 reported no sexual side (erections, testicular swelling, etc.) effects after 9 months. Among the few men that have reported sexual side effects (AS I RECALL NOT EXACT NUMBERS) there was under 10 total. 8 of those reporting any side effects were under the placebo group and 2 were men above the age of 60.

 

Edit: to truly know if the drug affects you in some direct capacity. I would suggest getting tested at your doctor. I know some places can conduct trichotests where they test your dna and match how specific compounds, drugs, other elements correlate with your capacity to 'tolerate' a specific medication and how well it will best work for you. If not you can always try the drug in smaller dosages, or try it for a specific period of time. But the best way is to see your physician and talk to them directly about any concerns you face. (not you directly Narmak but anyone who is considering any medication)

Edited May 3, 2022 by Vann

[deeznuts]

How stable is your loss? How old are you?

[Future Hair Doc]

Are you open to trying topical finasteride? How about oral or topical minoxidil? Like others have mentioned, you'll be chasing your hair loss. Do you have good beard and chest hairs? That can be used as fillers behind the hairline.

[Melvin- Admin]

3 hours ago, NARMAK said:

Also, in complete fairness didn't you stop due to side affects once you finally did get on Finasteride? 

I think side affects are a very real thing, but it seems like the vast majority of men who take the medication generally tolerate it well and without serious side affects that would hopefully help them keep their hair for much longer. 

I do wish though we get much more effective treatments soon because i think in 2022, it's pretty weird we have had the same treatments from 1997 or so to rely on right now and not made any in roads despite the issue affecting billions. 

Yes I stopped due to side effects. I would advise most to try it first, but I would most certainly go with topical version. 

[didu911]

10 hours ago, Melvin- Moderator said:

I have had 4 HT's now and I don't take finasteride, nor did I take finasteride when I started my journeys. However, I will be trying the topical version. Back when I had my first HT in 2014 topical finasteride didn't exist, unless you had it compounded for a ton of money at a pharmacy.

I think this is a quite controverse topic and really depends on the expectations.

Seeing your results on a NW6 are stunning for sure,

but If I would be you, looking handsome with a shaved head (we saw this in your eugenix video ), I would clearly vote for that for that instead of your current state.  

 

 

 

[RTC]

However, I currently seem to be losing minimum 50+ hairs a day.. starting to wonder whether I should try Finasteride even though I don't want to. Want to plan for a child soon and obviously don't want sexual issues.

[baldingeagle_]

I should have uploaded more details/photos with the original post - apologies. 

• I am 24M
• Started losing hair at 18
• My dad has a big bald spot at the back (like mine in the first picture) but overall has way more hair than I do
• My uncles on my mom's side (30s) have a hair density similar to mine in the photos, if not a little more
• I don't think my hair loss has stabilized - last year this time, I had noticeably more hair on the front/top (photo 6 w/ yellow stole: May 2021)
• Very hairy chest. Hairy beard (photo 7: June 2021)

Topical finasteride - will have to read about it but in general, for me, even the remote possibility of persistent* side effects is a no-no. 

The original question was re: finasteride and HT but some additional questions:

• Would you say I'm a Norwood 6? higher?
• Any other thoughts on the feasibility of FUE given my hair condition and above details? 
• If possible to estimate by looking at photos, how many grafts would you imagine I'd need?

* https://pubmed.ncbi.nlm.nih.gov/28289563/

 

In the first 5 photos, the last haircut I got was ~10 days ago.

Edited May 4, 2022 by baldingeagle_

[Mike10]

I understand your concerns about Fin. Sides on Fin are not as rare as some members want us to believe. That being said, I have serious doubts whether you should go ahead with a HT given your specific case. 

[baldingeagle_]

22 minutes ago, Mike10 said:

I understand your concerns about Fin. Sides on Fin are not as rare as some members want us to believe. That being said, I have serious doubts whether you should go ahead with a HT given your specific case. 

"serious doubts" - based more so on reluctance to take Finasteride, or current state of hair? Thanks!

[NARMAK]

9 hours ago, Aslitarcan sucks said:

However, I currently seem to be losing minimum 50+ hairs a day.. starting to wonder whether I should try Finasteride even though I don't want to. Want to plan for a child soon and obviously don't want sexual issues.

Depending on your hair loss level (Norwood scale wise) it's not uncommon imo to lose between 50-150 hairs per day on average as part of a normal hair cycle. Because you are also dealing with normal male pattern hair loss, you are probably just being even more sensitive to it because of that. 

You can stop Finasteride whilst trying to conceive i believe and resume it after without much worry unless you are really prone to somehow having hyper aggressive hair loss and somehow lose it all after stopping for a few months. 

3 hours ago, baldingeagle_ said:

I should have uploaded more details/photos with the original post - apologies. 

• I am 24M
• Started losing hair at 18
• My dad has a big bald spot at the back (like mine in the first picture) but overall has way more hair than I do
• My uncles on my mom's side (30s) have a hair density similar to mine in the photos, if not a little more
• I don't think my hair loss has stabilized - last year this time, I had noticeably more hair on the front/top (photo 6 w/ yellow stole: May 2021)
• Very hairy chest. Hairy beard (photo 7: June 2021)

Topical finasteride - will have to read about it but in general, for me, even the remote possibility of persistent* side effects is a no-no. 

The original question was re: finasteride and HT but some additional questions:

• Would you say I'm a Norwood 6? higher?
• Any other thoughts on the feasibility of FUE given my hair condition and above details? 
• If possible to estimate by looking at photos, how many grafts would you imagine I'd need?

* https://pubmed.ncbi.nlm.nih.gov/28289563/

 

In the first 5 photos, the last haircut I got was ~10 days ago.

Ideally you need medication to help you save whatever you can right now and Finasteride is the first step usually, then for you i wouldn't even hesitate to say Minoxodil in combination with Microneedling once a week at 1mm to 1.5mm is almost necessary. 

The last option really right now to be frank with you if you don't want to do any of the above is to buzz your head and wait till your mid 30s to see how it shakes out in a decade. Your loss is aggressive and likely to continue for a while without any interventions. 

Topical Finasteride is the alternative but based on your wording it does seem like you feel you don't want any sides at all being possible. 

[Britanium]

The Norwood 6 pattern is very clear, without meds it seems you’re predisposition is to keep losing hair at a accelerated rate. With such a level of loss already then it’s more than likely you will continue to lose ground. So what remains on top and even the sides “could” drop. From what I can see though you don’t yet have usual dipping in the crown area that’s usually evident in Norwood 7s. 
Proceed with extreme caution here, a lifetime of chasing the loss, a lot of time money and effort for a uncertain outcome. I would try the usual shaving it off, it suits some people (definitely not all) and with a good Beard can be a great look. 
Even if you chose some of the most elite Drs i think they would strongly suggest Fin in your case before even considering a HT. Think about this, if you was to continue to lose ground (very Likely) and you thin out your donor area and now have additional scars to contend with, FUE or FUT, maybe both.. you may end up wishing for your unscarred scalp back.. 

It depends on your goals and expectations, consult with only the very best choices though ! Spend time looking through the higher Norwood levels here and see what you can realistically achieve. 

[Mike10]

47 minutes ago, baldingeagle_ said:

"serious doubts" - based more so on reluctance to take Finasteride, or current state of hair? Thanks!

Both

[RTC]

1 hour ago, NARMAK said:

Depending on your hair loss level (Norwood scale wise) it's not uncommon imo to lose between 50-150 hairs per day on average as part of a normal hair cycle. Because you are also dealing with normal male pattern hair loss, you are probably just being even more sensitive to it because of that. 

You can stop Finasteride whilst trying to conceive i believe and resume it after without much worry unless you are really prone to somehow having hyper aggressive hair loss and somehow lose it all after stopping for a few months. 

Ideally you need medication to help you save whatever you can right now and Finasteride is the first step usually, then for you i wouldn't even hesitate to say Minoxodil in combination with Microneedling once a week at 1mm to 1.5mm is almost necessary. 

The last option really right now to be frank with you if you don't want to do any of the above is to buzz your head and wait till your mid 30s to see how it shakes out in a decade. Your loss is aggressive and likely to continue for a while without any interventions. 

Topical Finasteride is the alternative but based on your wording it does seem like you feel you don't want any sides at all being possible. 

Thanks Narmak

You may be right

Thank you for your sensible outlook as always 

[ciaus]

Looks like you've got some thinning in your donor already too. I wouldn't bother starting down the HT road, even with finasteride. Unless you turned out to be a hyper-responder on finasteride re-gaining and maintaining for a number of years first. 

Save yourself the headaches, worry and money. Grow your beard out and shave your head now. Maybe a hair system or SMP if having no real hair is unacceptable.

 

[baldingeagle_]

Thank you all for your insight! I think I will make peace with the fact that my days with a head full of hair are well past me - thanks for helping me reach that conclusion.

[LaserCaps]

On 5/3/2022 at 3:57 PM, baldingeagle_ said:

Hi, 

I am starting to research FUE options. I am probably between Norwood 5 and 6. My first question is: is it possible to get FUE and not use finasteride after, without negatively impacting the transplanted hair? I have spent a fair bit of time researching finasteride and have firmly arrived at the conclusion that I would not like to take it. Given this, is it still a good idea to get a transplant? I would really like to have a head full of hair again but certainly not at the risk of the finasteride side effects. For context, I am located in the US (in case that's relevant in terms of the surgical procedure norms here - I read somewhere most surgeons wouldn't do FUE unless the patient agrees to commit to finasteride post-surgery?).

Thanks for any thoughts you might have on this!

Well, before you give up.....

You are thinning diffusely through the pattern.  Lots of miniaturized hair that have not left the building.  Those could be not only kept but also enhanced.  OK, so you do not want to take Fin? Fine.  The med, by the way, is now available as a topical solution. Then you have Rogaine, PRP and Laser.

Fin and Rogaine are considered the best meds for retention in the crown.  The problem is expectations.  Many patients become frustrated a year later when they see no visual change - not understanding, the meds are not intended for you to grow anything.  Rather, they are to help you with retention.  So, if a year later you look the same, the meds did what they were intended to do.  PRP and Laser can help reverse the thinning.

There are two types of loss. The type you see and the type you don't see.  What you see in the comb, shower, sink, etc., is normal.  The follicle gets tired of producing hair and it goes into a dormant period.  3-4 months later the hair will return.  This will happen randomly to all the hair in your head.  Hair loss is different.  You don't see it.

Under a bright light look at each strand.  You'll notice some nice and robust.  Others not so much so.  We refer to this as miniaturization.  Eventually the hair dissipates and disappears.  That's hair loss.  

My suggestion would be to do as many of the modalities as you can, or want to do.  Give them a year.  Takes photos in the interim.  A year later you can decide if the time, effort and cost are worth continuing.  (It truly takes a good year to see what the meds will accomplish). In the meantime, you could start transplanting the front and mid-scalp.  Leave the crown as is for now.  Once happy with the results in the front, and confirm the meds are working, you can then move farther back with transplants.

FUT and FUE are available to you.  Considering both will give you access to your entire donor area.

Now, if you don't want to use any of the meds....Go to the mall and window shop.  Start looking at people, particularly those with an advanced pattern.  Notice they tend to keep a forelock, well receded temporal areas, little to no density in the mid-scalp and an empty crown.  If that's the look you're looking for, you can pursue it.  Just be judicious with your grafts.  Once gone, you'll never get them back.